If you have been feeling breathless, weak or tired lately, you may have
anaemia. Women are particularly prone to this condition, in which the blood
is lacking in the red protein molecules that carry oxygen around the body.

There can be many obvious causes for feeling tired and low in energy, such
as a bad night's sleep. However, if you feel like this for no apparent
reason, you could be suffering from anaemia.

LACKING OXYGEN
The symptoms of anaemia result from the body tissues being deprived of
sufficient oxygen for their needs.

Oxygen is carried around the body by our red blood cells. These absorb
oxygen from the lungs into their red protein molecules called haemoglobin.
Red blood cells are then transported around the body by the circulation and
eventually release their oxygen into the body tissue cells. Then they return
to the lungs where the process begins all over again.

Concentrations of haemoglobin in the blood are regulated by the dual action
of the bone marrow (where red blood cells are made), and the spleen (where
they are eventually destroyed). If this balance is upset, however, you may
become anaemic. There are a number of reasons why this can happen but the
most common is a lack of the mineral iron in the body.

Normal blood concentrations of haemoglobin are in the range of 13.5-18g of
haemoglobin per 100ml of blood for men, and 11.5-16g per 100ml for women. If
your blood concentration falls below l0g per 100ml, you are likely to feel
washed out and tired and you may get headaches.

SEVERE SYMPTOMS
If your blood concentration falls to below 8g per 100ml, you may experience
far more distressing symptoms such as breathing difficulties and
palpitations. The degree to which you are affected also depends on how
quickly the anaemia has developed. When it develops slowly, you may notice
very few, if any, symptoms until it becomes quite advanced.

If you experience some of the above symptoms, your doctor may decide to give
you a blood test to see if you are anaemic. The test will confirm if anaemia
is the cause and give clues to why the condition has developed. Under the
microscope, the blood cells in the sample will be counted and closely
examined to see if they appear normal.

Further tests may be needed, such as measuring blood levels of some of the B
vitamins and, rarely, screening of the bone marrow cells by taking a biopsy.

IRON DEFICIENCY
If your body becomes short of iron, your haemoglobin concentration will
suffer because iron forms an essential part of haemoglobin. The bone marrow
which produces haemoglobin and packs it into red blood cells won't be able
to do this part of its job properly.

Besides being needed by red blood cells, iron is also vital to growth.
Slimmers, old people, children and teenagers all have an increased demand
for iron and should take extra care when it comes to their diet. Up until
the menopause, women lose small amounts of haemoglobin every month in their
periods. Haemoglobin is also lost from bleeding, from the skin cells our
bodies are constantly replacing and from the lining of the bowel in the
faeces. A tiny amount is also lost when the red blood cells come to the end
of their lifespan, although much of their iron is extracted and repackaged
into new red cells.

Menstruating women tend to have low or no iron stores, so they quickly
become iron-deficient if they are not getting enough from their diet to
replace the loss.

Some digestive tract disorders cause bleeding which can lead to iron
deficiency anaemia. Other disorders such as coeliac disease will interfere
with iron absorption.

OTHER SYMPTOMS
Besides the symptoms already outlined, iron deficiency anaemia can cause
brittleness of the nails and soreness in the mouth and tongue. If the lack
of haemoglobin results from bleeding in the digestive tract, there may be
abdominal pain and black faeces.

Iron-deficiency anaemia shows up in a blood test as a low level of
haemoglobin and red cells which are smaller and paler than usual. If
internal bleeding is suspected, further tests may be carried out.

When there is an obvious underlying cause, treating it should cure the
anaemia. Surgery, for instance, should stem internal bleeding. Otherwise,
the treatment is simple enough - a course of iron supplements or injections
to build up iron stores and a diet high in iron-rich foods.

A LACK OF B VITAMINS
Another form of anaemia, known as megaloblastic anaemia, is also caused by a
deficiency of vital nutrients - in this case vitamin B12 or folic acid. If a
shortage of either occurs, too many cells called megoblasts are manufactured
by the bone marrow. This gives rise to enlarged and deformed red blood cells
called macrocytes.

The most common cause of B12 deficiency is the stomach failing to produce
intrinsic factor, a chemical vital to B12 absorption.

Often an auto-immune disorder is to blame for this, where the body
mistakenly attacks and destroys its intrinsic factor. This is known as
pernicious anaemia and often runs in families, affecting more women than men
and beginning in middle age. Another intestinal disorder called Crohn's
disease can also upset the absorption of B12.

Heavy drinkers are vulnerable to vitamin deficiency, especially of folic
acid, as alcohol robs the body of B vitamins. Crohn's and coeliac disease
can also interfere with folic acid uptake.

MEGALOBLASTIC ANAEMIA
Megaloblastic anaemia shows up in blood tests as low levels of haemoglobin,
an excess of large red blood cells and low levels of B12 and folic acid. The
diagnosis can be confirmed with a bone marrow biopsy if a preponderance of
megoblasts (abnormal immature red cells) are observed.

In cases where the doctor or specialist suspects that you have pernicious
anaemia, a test known as the Schilling test will reveal if this is the root
of the problem.

Folic acid tablets and vitamin B12 injections will help correct any
deficiency caused by inadequate diet. These may be continued for life in
those where the underlying cause cannot be treated.

DESTROYED EARLY
Haemolytic anaemia develops when red blood cells are killed off prematurely.
Normally, red blood cells are only killed off when they are worn out or
damaged and the bone marrow compensates by producing new cells. If it can't
keep pace with the destruction, however, anaemia will inevitably develop.

Haemolytic anaemia is often caused by an inherited disorder such as sickle
cell anaemia - a condition affecting mainly black people or those of
Mediterranean origin - which is characterized by deformed red blood cells
and a resistance to malaria.

WHY RED CELLS DIE OFF
In some cases, the red blood cells are quickly damaged by unusual buffeting,
for example against a blood clot or a replacement heart valve. There are
also a number of auto-immune disorders which cause the body to attack and
destroy red blood cells.

People with haemolytic anaemia can also experience jaundice caused by too
much bilirubin - a yellow pigment produced when red blood cells are broken
down - in addition to the more common symptoms of anaemia.

In some inherited disorders, the red cell destruction can be reduced by
removing the spleen - their main site of destruction. In others, avoiding
certain drugs and foods that trigger red cell death will help the
condition.. Damage caused by buffeting can be prevented by reducing the
disruptive forces.

TREATING DISEASES
If an auto-immune disorder is causing the problem, red cell destruction can
be controlled with immunosuppressant drugs, which prevent the immune system
from attacking the body's own cells.

Acquired diseases like malaria, which cause haemolytic anaemia, need
specific treatment for the disease itself. In severe cases of all anaemia,
whatever its cause, emergency blood transfusions may prove vital if the
condition has become life-threatening.